CO-46: Non-Participating Provider
CO (Contractual Obligation)What is CO-46?
CO-46 is a Contractual Obligation code indicating the payment was adjusted because the provider is not participating in the payer's network. The out-of-network rate was applied instead of the in-network contracted rate.
Why Does CO-46 Occur?
- Provider is not contracted with the patient's insurance plan.
- Provider's contract with the payer lapsed or was not renewed.
- Claim was routed to the wrong payer network (e.g., billed to the national plan instead of the regional BCBS plan).
How to Fix CO-46 Denials
- Verify your network participation status with the payer.
- If you are in-network and the claim processed as OON, submit proof of your contract and request reprocessing.
- If you are truly OON, the payment reflects the OON allowed amount. Balance billing rules vary by state.
- Check state surprise billing laws before balance billing the patient.
CO-46 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | Varies | 60 days from remittance | Reconsideration required before formal appeal. |
| Anthem | Varies | 365 days from denial notice | Check state-specific provider manual for variations. |
| Aetna | Varies | 180 days from denial | Strict in-network filing enforcement. |
| Cigna | Varies | 180 days from denial | Cigna COB team: 1-800-244-6224. |
| Medicare | Varies | 120 days (redetermination at MAC) | Five levels of appeal starting with MAC redetermination. |
Related CARC Codes
If you are seeing CO-46, check these related codes: CO-16 (claim differs), CO-45 (fee schedule), CO-29 (timely filing).
Common Questions About CO-46
What does CO-46 mean?
CO-46 indicates non-participating provider. Check the RARC code on the EOB for the specific reason and follow the resolution steps above.
Can I appeal a CO-46 denial?
Yes. Commercial payers allow 60-365 days to appeal depending on the payer. Gather supporting documentation before filing. Medicare allows 120 days for a redetermination request.
Altair catches CO-46 denials before submission with network status verification. See how pre-submit claim scoring works.